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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDER DEL('ARA ION
<br />I hqeby amrn undtr toalry oa pdjury rhar I dn cx.npi 6on lh. Conlnclo6 l-icmc law foi dE followin! r6on {S(.?01 1 .5
<br />Busin6s &d ProfBion Cod.) Anr Cny or Coudr \rhich rcqutB a ponn lo codtu t, nlid, inprove d.nolish or ra.t Ary
<br />fl.rurc, prior ro irs isuance al$ r€qun6 rhe aDplicanr lor such p.mn to fi1. a si8ned sl0lmdl lhat hc or dr€ n li.d$d pGtrMl
<br />ro rhc provisnrtu oa rhc Conf.cro.s Licens.d l-ns (ChaDl6 9. Co'nrcncin! $irh sarion 7000 of Division ] of th. B,sins and
<br />Proaessnnu Codc) or rhal hc or shc N cicnpr rhdcannn dd thc bsis for rhc ollescd ero.Fio. Aoy violalion oas.dio.70 l.5 by.ny
<br />appli.anr loi.pendt srbjeIs lnc applica ro acivilp€n.hyofnot norerbd nv. hun&.d dollds {$500).
<br />I- as o*Td oflhe lropoly. or ny .nvloyes qilh wag.s s thet el. compflsation. will () fi. {orl and thc stnxlue is nol
<br />in(sdrl or orl6.d for ele (s- 7044. Busins d ,tofsioE Code th. Conlrrcroas Licffi t \r do6 nol q,lly ro d o\nd ol
<br />rhc pmFny u ho blilds or impror6 lh6on. dd *ho dc s .h $o'l nimsclt ot l'6.11or rhrcush his or ho otn mployc6.
<br />tlovid.d thar su.h nrprc1lmots a€ nol inlodcd or otrs€d ror elc Il ho( 6'e. (hc brildins or in\Tovml is $ld wnhin on. ,a
<br />ofcompErio.. llE o\vo6 Buildc $ill ha!. rh. hndft of pmltu that lE or sh€ did nol build or nnrre\. $. popoly for lh. purFs ol
<br />I, N o$rs olllE !yopq1y. an exchNivelyconrraclina rilh hchsd coitadoB
<br />'o
<br />cotrslfld lhc prejcl (S(. 7044, a*rd
<br />and Ltofsion Code 'l hc Co.lradr's l-i.enc Lr* doe nor appl! lo .n o$nr ol pror.rly who builds o. inrprov.s thean.
<br />snd sho onters foi sch lrojNrs silh. Contraclo(s) licaFd pu6u l ro rhc conra.bis LicN tis)
<br />I an eienfl undtr s{rnJ.
<br />Drre: Okn..
<br />w oRl<l rrs. (T)NIPEN:SAT|oti
<br />DECI6f,AIIO!
<br />I h6eby ,rlim u.d6 poalry .f ,6jury o.. o f lhe lollosinB ddlmtionsl
<br />Ih.vc d s ill minlain a ccdin.al. olconsmr to scll-lBurc lor tr orkqs conpensa'io...s prcvidcdlorbySction1700ortht
<br />t,abor Code lor thc DElo@o.c ollh. *ork lor $hi.h rht pdnn is isued.
<br />\f m'c ua *ltt mainrain lo 6 conp€marion insurance.6
<br />r1r. s.'k lor \l'ichrhisn rEir is issu.n M! \crldr curnr'.nsdl
<br />,*a rtnt&'otol 4..f
<br />r,t^, r-'t. 7 L u)ELA^L$u L
<br />Equt.d by 56rion 1700 oflh. bbor Cod.. lor lh. p6hme. of
<br />io. isuroc. .mid dd policy nurb6 ec
<br />,.,,,*, {//tL|-L
<br />I c.nifylhal in the perlormancc oflh. work lor *hi.h rht p.r'nn k issrcd, I shall nol oploy aoy p.en in tn, mmn€r
<br />s, s lo b.con. subjd r. rh. $ oi{6s .o,npmerion lavs ofcalifonia, and alre rhar if I should b..ome sublat lo lh.
<br />sork6' .orpdsarion tmvhions of Sdion 1700 of rhe LaUr CGle I snall. fonh(nh snply wirh thos pmvisiols
<br />w ltNlNC Fa,lurc lo wurc {oikdl co'npsMtion coveraBe is ufllasfi']. and shall sub.jdr nn mFlo}er io oi,ninal poahi6 dd
<br />c,vil fin.s up ro onc hun&en Ihorsd dollds (1100.00{}. in addnion lo rhc c.st ol.onr.nsrion, ddnas6 6 prolded aor rhr
<br />sdrion 1076 olrhr ljtBr Codq intd6r afld aitom.y s f6
<br />^", //"'t/ z "
<br />t)t.(t,\R\rx)\
<br />I hedby arrm undd p6ah, ol p6j,ry lhd I 0m licascd under p.ovisi.n orChapro 9 (.o,nmocin8 lti S(lion 7000) olDivisi.n
<br />of rh€ B6ins &d ltotsio6 Code, dd myli..Mis i. tulllolceddellql.
<br />F,
<br />tJ-L
<br />CONIIAISISILIEIDING.AGEICT
<br />I hccby rffm undd F.lly of pdjury thal th6c is a consltuclion lcndins lsncy for lh. pdfoflrme of th€ sort 6r *hich lha Frnn b
<br />issu.d (Sd. 1097. Civ. C.).
<br />Lcnd6 s Namc:
<br />-a-8tltcarlDltcLABAllo!
<br />l,E-r!."'q amnnundd paahyolpdjury ooe ollh€ lollo\inr dshrarioisl
<br />Den(lirion Psnne^sbd(os Noliicolion Fcdtr.l Rcsulaliols OnL 40. Pan6)
<br />R.nund I-drcr oaNolifi caion
<br />lL I din rharrlE a.d6alrcsuiarntu rcsardrnc ab6 "s'odulde noripphrabl. r. thE pror(.
<br />Llfli cdib
<br />'har
<br />I ha,c @d rhF aFnh.ari.n ad s.r.rh.r th. abov. inromrion is cor6r. I agrEro coftply*irh.ll cnyand counry
<br />lordmancBddskrcLausEl,'n!'ohuLldrn!coslrudiotrddhdebyaulhorizercprsot.li\,6ofrhiscnyedcounlylodl6uponlhc
<br />aMr. rndriooed u oD.rly for iDspd
<br />\Dpliutrt...\st r Sis ilurc
<br />l,**,*,,.",,n*,, v/d4e r /x "/a 1c L///z:/za
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />NIeter Release
<br />Rouqh
<br />Service Meter rl
<br />>ltvlao>oFINAL flrfwoLl
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />.ll & P( ror(ha r.don
<br />,-".*.a,-. il
<br />,"" //so/z-,^"**,, 4a2r41.1I
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